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HPPLICATION FOk ���,�„ <br />'"'E"'°'"" CONSTRUCTION � <br />�,r o. <br />everett PERMIT <br />BUILDING DEPARTMENT <br />259•8745 TO BE COMPLETED IN INK - PLEASE PRINT <br />O DEMOLITION ❑ COMBINATION ❑ BUILDINO ❑ MECHANICAL ❑ PLUMBINO ❑ SIpN <br />OWHER M�IL�OORE39 CITV ZIP VNONE <br />�' �i � � � �=� �i r�r- ,:,�,-,u.;�tr-Fr�ctr►•- r'4�t �c-�r ��� • .�..;�,.,�i,:� <br />•RCNtlECiOROE51 NEA M�I��OORE39 CI1V 210 PIIUNE <br />_ /'�� . •.... .nnn�nn �irv )It� I� 1 � �/\ OMl1NL I lf[IJC[ • <br />'-, ; :- r •_"',1 (:S �"�1"Ir;1 � il� 31 1.29�L� /�U /LA ll'ln��l��.i/u lU�.� - <br />5 Tc/Zrv9C.�(�3.DT <br />PIUMBINOCONT9�CiOR M11LAO�AE55 CIIY ZIP PIIONE � L�CENSE• <br />:LWSOf WORK <br />❑ NEW J� ADDITION ❑ ALTERAiION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPI.INSERT ❑ BUIlDINO RELOCATION <br />I �1�Vq� <br />INO <br />����-�� : �i�_t— � <br />�- 1 <br />lOt �BIOC�—J--�Of_U <br />WRTER <br />��� �Y_ � �t.�-�`i /V '� � <br />O W 00 �11�CN fOUR COPIESI <br />j= t��r,v�'•�_ii1=,��r <br />;� l.'�7C'�i�t.�_ <br />;r ; �, f"1 �:1' r�- <br />��c'�A/�� r;�l" 'fTV=t'L1� � <br />'�'F �.`_FLi.LC�I� - <br />f75 <br />I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIiIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES OOVERtJING THIS TYPE <br />OF WORK WILL BE COMPLE � ED WITH WHETHEA SPECIFIED IiERE• <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULAiING CONSTRUCTION <br />OF THE PERFORtd�NCE OF CO'�N.�S�TR�UCTIQN. <br />SIQN�IUREOFC01iTAi:CTOP�pAUTyyrrceorlOfNJI /' O�TE <br />X � <br />NO. <br />801 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />iPONI5E1n9�Cn fi[�R;;EI/fi�.\CK SIOESEIBACK PUNCNECNNU�BER VUNC��ECKFEE <br />GO ` FO) 5' O/_ /I �J�3 � iEE �� I nECEIPf NO �. 3L' I� <br />.._.- .....: ....: . :.-, YJ <br />....�...../J if I.......,�., iMC�NTy$��fE ��E9 I V�LU�TION FEE � <br />/�' <br />�a � �io orrs onu <br />'x3o� 2 <br />���UU��ON �Cf, Br <br />rn-M � <br />❑YES 0 <br />NO OF OWFIIING UNIIS <br />1 <br />M�% OCC IOAp <br />N� <br />R FORISSU�NLEBY <br />L�C. <br />BUILDIN6 <br />PLUMOING <br />MECHRNICAL <br />OTHER <br />PENALTV <br />TOT�L <br />CC <br />